Police and ‘confused persons’
Study into police action in relation to persons displaying confused behaviour
Manja Abraham Oberon Nauta
Summary
Police and ‘confused persons’
Study into police action in relation to persons displaying confused behaviour
Manja Abraham Oberon Nauta
Amsterdam, 10 september 2014
Manja Abraham
mabraham@dsp-groep.nl
Oberon Nauta onauta@dsp-groep.nl
Dit onderzoek is uitgevoerd in opdracht van het WODC, afdeling Extern Wetenschappelijke Betrekkingen, ministerie van Veiligheid en Justitie.
©2014, WODC, ministerie van Veiligheid en Justitie. Auteursrechten voorbehouden.
Summary
Reason for the study
The police and confused people
Operational police staff regularly come into contact with civilians with psychological and/or addiction issues who cause inconvenience and (feelings of) insecurity. These are considered to be ‘confused persons’ who cause inconvenience, require assistance, languish, act dangerously or commit offences. The police estimates that they spend a considerable part of their capacity on this group of
‘confused persons’. A reason for this is that the police are available 24 hours a day and therefore can be called upon at all times.
In the case of a confrontation with confused persons, the police always chooses to act independently, or to (also) appeal to mental health care services (in Dutch: GGZ). Mental health care services can also call the police for assistance. In view of this reciprocal dependence, a good collaboration between the police and mental health care institutions is important. In order to facilitate this,
cooperative agreements have been made in a police – mental health care covenant. The covenant is a national framework that is brought into practice regionally, so the execution of the covenant differs per region.
Study
The Directorate General of Police (DG Police) of the Ministry of Security and Justice requires information about the capacity the police spends on actions that stem from the behaviour of confused persons and the nature, quality and achievement of objectives of the collaboration between the police and mental health care services and the meaning of the covenant in this. By order of the Scientific Research and Documentation Centre (Wetenschappelijk Onderzoek- en Documentatiecentrum;
WODC) of the Ministry of Security and Justice, DSP-groep has executed research into the topics stated.
The central definition of the problem is:
How much of its capacity does the police spend on actions that are the result of problematic behaviour of confused persons and to what extent do the police and mental health care services make efficient and effective use of each other’s competencies and authorities?
The field work of the study was carried out in the period from October 2013 to April 2014. Various methods were used in the study. Firstly, laws and regulations were studied and various written sources analysed. In addition, in four former police regions, thirty semi-structured interviews were held with mental health care portfolio holders of the police, executive police staff, mental health care employees and employees of other parties that are (also) connected to PMHC networks1. A survey
Note 1 The public mental health care (PMHC) is a responsibility of the municipality indicated by the national government and the execution is commonly carried out by a mental health care service (Municipal Health Service) and/or a mental
was conducted among 600 police staff of the basic police care2 (police officers, senior police officers, police sergeants functioning in community policing, police officers on the beat and emergency assistance) in four former police regions. Overviews from the Basic Law Enforcement Database registrations were requested from the national police and extensive research into the Basic Law Enforcement Database system itself was executed at the Amsterdam regional unit.
Scope of the research and definition of a confused person: the perspective of the police The perspective of the police organisation was adopted in the study, meaning that the collaboration concerning confused persons was considered only to the extent to which the police plays a role in this. As already known, the greater part of assistance to confused persons takes place without police interference, which inherently results in a one-sided view because the task of the police with
confused persons often differs in essence from that of other collaborators. Although the 2012 police – mental health care covenant is a major part of this study, this study is not an evaluation of the covenant.
The term ‘confused person’ is central to this study, however, the term is not univocally, and the concept is also ambiguous in practice. In this study, a definition was selected that fits the perspective of the police. A 'confused person' is referred to as ‘anyone who, due to their (temporarily) disturbed judgment, displays behaviour which causes him/herself or others to be at risk of danger and/or poses a threat to public order and safety’. This definition thus differs from that of a confused person as set out in the 2012 police – mental health care covenant (also see research results).
Research results
Legal framework
The legal framework for police action concerning confused persons is provided by the 2012 Police Act, the Official instruction for the police, the Royal Netherlands Military Constabulary and other investigating officers (1994 Official instruction), the Psychiatric Hospitals Compulsory Admission (Dutch acronym: BOPZ) Act and the Penal Code. The study demonstrates that the legal framework leaves certain issues undefined, for instance: the police actually lacks a legal ground for holding a confused person if this person does not (yet) have a legal title under which compulsory psychiatric
health care institution. Ideally, there is a close collaboration between these institutions. In addition, other institutions such as the police, municipal social services, welfare organisations and social landlords participate in consultation structures.
Note 2 The police work is subdivided into basic police service and specialist tasks. Although the term basic police care is not univocally defined, the police broadly considers it to involve the following tasks:
Daily police supervision. Police presence in the streets prevents violations and criminal offences.
Prevention. Tips concerning the prevention of burglaries, for instance.
Traffic. Alcohol testing, investigating traffic accidents and providing the municipality with traffic measures (such as adjusting speed).
Investigation and forensic investigation. Detectives investigate theft and burglaries, while a forensic expert investigates DNA traces, for instance.
Assistance.
Enforcement. The enforcement of laws and regulations in the area of weapons and ammunition and closing times of catering establishments and shops.
As soon as specialist knowledge is required, for example to investigate traces after a burglary, the police officer calls in specialists such as technical and forensic detectives. In addition to these tasks, the police ensures the accurate reporting and dealing with reports. (source: www.politie.nl)
treatment can take place (a remand in custody by order of the examining magistrate or court order).
In addition, it is not established in every situation who is responsible for the transport of confused persons.
2012 police – mental health care covenant
The legal task of the police is to provide emergency aid and indicate the need for care for confused persons. In the case of a crisis situation in which a confused person threatens public order or security, or poses a danger to him/herself, the police is responsible for maintaining public order, limiting trouble and securing situations. The mental health care service is responsible for a rapid assessment if psychiatric issues are suspected, for the organisation and provision of the proper care provision on indication and to provide advice to those involved. Non-urgent long-term care is a task of mental health care services and other social workers. From its statutory function , the police will act to support, alert, advise and refer.
Because the current legal framework does not provide any further crystallisation for various
components of the collaboration between the police and mental health care services and both parties believe that the implementing practice could be more efficient and effective, in 2003 the police and mental health care services entered into a national covenant. In 2012, a new police – mental health care covenant was drawn up, and the new covenant provides for solutions to issues in the area of:
1 Accessibility and availability 2 Custody and assessment 3 Registration in mental health care 4 Transport
5 Exchange of information
6 Missing/unauthorised absence from a mental health care institution
The covenant does not cover everything, but does provide a national framework to regionally crystallise local issues. According to the Chairman of the national police platform (Landelijk platform politie) and mental health care, the basic assumption of those who drafted the covenant was to regulate 80% of the collaboration process and leave the remaining 20% to the shop floor to organise.
Collaboration
Within the collaboration concerning confused persons, a clear distinction is made between a crisis situation and non-acute care because there is a difference between the manner of compliance to a report in these two types of care. As regards acute situations, there are similar collaboration partners in all four of the former police regions studied: the police collaborates with mental health care services, the Municipal Health Services and the ambulance service. The task and identification is elaborated in local agreements that are in some cases included in formal local covenants. The current situation may be regarded both as a complementary collaboration (identification) and an integral collaboration, and removes a substantial proportion of the issues that prompted the formulation of the second covenant. The type of collaboration involved depends on the case.
As regards the non-acute long-term care, the collaboration concerning confused persons between the police and other healthcare providers is dealt with regionally or locally and is thus less uniform: in some cases the participating parties differed considerably. The role of the police in the non-acute
domain is commonly limited to the indication and reporting of confused persons in the consultations referred to, or providing information to these consultations concerning the situation on site or
providing assistance to care during house calls, etc. In the non-acute process, the role of the police in practice is much more limited than with the acute process, but this role is more common according to basic police service employees. There is a clear complementarity within the collaboration concerning the division of responsibilities between the police and other health agencies.
With the introduction and further elaboration of the 2012 police – mental health care covenant, a clear improvement is observed in comparison with the previous period of time. About two-thirds of basic police service employees believe that the collaboration relating to confused persons in both crisis situations and non-acute situations is reasonable to good. However, two-thirds of the police also indicate that there are points for attention. Issues stated include the (collaboration concerning) accessibility and availability of accommodation for confused persons in the reception facilities. The local covenant of one of the regions investigated determines that admission by the crisis centre (for new clients) is up for discussion only if the confused person is seen by a (mental health care) doctor first. The police believes that the intermediate step that results from the assessment on the spot by the (mental health care) doctor negatively affects effectiveness. In addition, the concern was expressed whether the coming of the transition and the increase in ambulatory care nullifies the collaborations currently functioning. Additionally, it was commented that it is realistic to assume that certain care issues cannot actually be solved and that attention should be focused on keeping situations manageable.
Confused person
The term ‘confused person’ is not clearly defined in the police organisation. In most cases, however, the basic assumption is that an impaired judgment or a disconnection with reality is concerned. The police has a wider definition of a confused person than the covenant.3 According to the police, a confused person may also be an addict, or a senile or mentally challenged person.
Police action
The study demonstrates that police officers believe that their efforts concerning confused persons is part of the regular task in basic police care. It is also found that police action following a report about a confused person is determined not so much by the type of confused person, but instead the fact whether a crisis situation or non-acute demand for care is concerned. Contrary to dealing with individual reports in crisis situations, the emphasis on police action in non-acute situations is more preventative by agreement with other healthcare players.
If the police acts on individual reports (acute and non-acute), the difficult behaviour of the confused person is the direct reason for deployment in about a third of the cases. An acute demand for care is involved in another third of the cases, and an offence in about a quarter. In one third of the cases,
Note 3 In the 2012 police - mental health care covenant, a confused person is taken to mean a person who is
reasonably suspected of a serious disturbance in judgment that is caused by a mental disorder. Mental disorders include:
a psychotic condition in which actions are the result of hallucinations or delusions, etc., acute threat of suicide, and organic brain diseases. In this sense, the following are not considered mental disorders: actions that are the result of an emotional response to an event, substance dependence and personality disorders.
police action takes place in public spaces, and in one quarter of the cases in the confused person's house.
Actions include a variety of proceedings, but most usually involve talking to people and mediation. In about one third of the cases, transport of the confused person to crisis care or a care institution (or home) is involved.
Police capacity
Reliable figures for the capacity the police spends on confused persons are not available in the Netherlands. Nonetheless, this study provides two indicators that jointly contribute to a picture of police deployment in this area:
A first indicator is based on the registrations in the business process system of the police (Basic Law Enforcement Database). The police works with a registration code (E33) under which it can take up reports relating to confused persons in its business process system (Basic Law Enforcement Database). Using file examination and surveys, the number of E33 cases which are actually connected with confused persons were considered. In addition, the extent to which relevant police action is registered under different codes was considered. This study calculates that approximately 6% of police action registered in the Basic Law Enforcement Database can be related to the behaviour of confused persons. This percentage is somewhat higher in the main cities compared to rural areas. It has to be taken into account that some police deployments concerning confused persons are not registered in the Basic Law Enforcement Database – like other deployments.
A second indicator is the amount of time employees from basic police care say they spend on this target group. Police employees of the basic police care interviewed (officers, senior police officers, chief police sergeants in the functions of community policing, officers on the beat and enforcement &
emergency assistance) estimate that on average they spend 13%4 of their entire working hours to issue-related police action concerning confused persons. As stated, some of these deployments are not registered in the Basic Law Enforcement Database. The two indicators above have the character of estimates and are thus not certainties.
The study demonstrates that the police employees interviewed believe that their deployment concerning confused persons is part of the regular work in basic police care.
Finally
‘Confused persons’ is an important theme within the work of the police and it appears to remain that for the time being. One third of the police employees have established an increase in the number of confused persons and the issues involved in recent years. Various parties expect this development to continue. It is conceivable that the increase in ambulatory care and the transition of care to the municipalities will result in confused persons endangering public order and safety more often, which in turn will result in increased police deployments. Thanks to the effect of the covenant agreements and the developments concerning collaboration in the public PMHC domain, however, the police
Note 4 Between 9% and 17%, 95% confidence.
seems to be becoming better equipped for the adequate supervision of this target group, certainly once the new and obligatory mental health care act (Wet verplichte geestelijke gezondheidszorg) is introduced.
The study also demonstrates that differences in tasks and responsibilities do not automatically involve an impediment for proper collaboration. As long as the parties are willing to keep the common objective in mind, the formal and legal limitations do not prove to be insuperable when adequately leading confused persons to the suitable care framework. It is possible that the collaboration between the police and mental health care services can thus serve as a proper example to collaborations between other parties that differ from one another with respect to their methods of working and objectives.
